Analysis Of Short-Term Blood Pressure Variability Markers In Pheochromocytoma/Paraganglioma Patients

Objective: Data about short-term blood pressure variability (BPV), whose changes represent a well-established cardiovascular risk factor, in pheochromocytoma and paraganglioma (PPGL) patients is lack and still conflicting. The aim of this study is to analyse 24-h ambulatory blood pressure monitoring (ABPM) derived short-term BPV markers in PPGL, before and after surgical removal of catecholamine-secreting tumour. Design and method: We retrospectively analysed PPGL patients with more than 18 years old, referred to our Hypertension Unit, Sapienza University of Rome, from 2010 to 2018. PPGL diagnosis, according to the guidelines, was assessed by 24-h urinary metanephrines, adrenal gland imaging, such as computed tomography scan or magnetic resonance and/or I123-meta-iodobenzylguanidine scintigraphy to localise extra-adrenal masses, and confirmed with histological examination. For each PPGL, at baseline and after follow-up (FU), markers of short-term BPV were assessed by 24-h ABPM, including: (i) systolic and diastolic BP dipping percentage, (ii) overall, daily, and night-time systolic and diastolic BP standard deviation (SD), (iii) overall, daily, and night-time systolic and diastolic BP average real variability (ARV). We also collected a complete clinical assessment, including past medical history, current treatment, and information about cardiovascular risk, physical examination and biochemical evaluation. Results: 24 patients (7 M,17F) affected by PPGL (52 ± 19 years old), were evaluated at baseline and after 27 ± 25 months of FU. The mean 24-h metanephrines was 457.6 ± 61.9 μg/24 h at baseline vs. 62.9 ± 29.0 μg/24 h at FU (p = 0.04). 37.5% of patients showed a physiological circadian pressure rhythm (dipping-pattern) at baseline and 41.7% after treatment. Comparing with baseline results, after treatment, we found a significant decrease of 24-h systolic BP ARV (8.8 ± 1.9 vs. 7.7 ± 1.6, p = 0.05), and a decreasing trend in 24-h diastolic BP ARV (7.6 ± 1.9 vs. 6.9 ± 1.7, p = 0.3) and 24-h systolic and diastolic BP SD values (Fig.1). On a multivariate analysis 24-h metanephrines values resulted predictors of 24-h systolic BP SD (r2 = 0.59, p = 0.009) and of night-time diastolic BP SD (r2 = 0.49, p = 0.024).Conclusions: Our study shows as in patients affected by catecholamine-secreting tumours, after successfully treatment, there is a reduction of short-term BPV indexes.